Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke

Abstract

BACKGROUND AND PURPOSE:High recanalization rates achieved with endovascular procedures are not always followed by the expected clinical improvement. These time-consuming procedures imply a delayed reperfusion despite the capacity of earlier intravascular microcatheter bypass to the ischemic tissue beyond the clot. We aimed to explore the safety and feasibility of MOB beyond the clot.

Stentrievers versus other endovascular treatment methods for acute stroke: comparison of procedural results and their relationship to outcomes

“…This unique feature of ST may prove to be of paramount significance, especially in patients with impaired collateral circulation, allowing them to buy time until final recanalization is accomplished. The negative impact of the duration of ischemia is especially pronounced in patients with a poor collateral supply9 and, in the past, different strategies have been described to improve collateral perfusion to the tissue at risk either by redistributing the flow16 or by creating an intravascular shunt 17…”

Real-time Validation of Transcranial Doppler Criteria in Assessing Recanalization During Intra-arterial Procedures for Acute Ischemic Stroke An International, Multicenter Study

“…However, the average delay between TCD and angiography was 29±52 hours, and the investigators included only patients with MCA occlusions. Postert et al 11 assessed the Male sex, % (n) 58% (36) Hypertension, % (n) 68% (42) Diabetes mellitus, % (n) 27% (17) Coronary artery disease, % (n) 24% (15) Hypercholesterolemia, % (n) 48% (30) Atrial fibrillation, % (n) 26% (16) Congestive heart failure, % (n) 15% (9) Current smoking, % (n) 36% (22) Median NIHSS score, points (IQR) 18 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21) Acute ischemic stroke subtype Large artery atherosclerotic, % (n) 42% (26) Cardioembolism, % (n) 37% (23) Infarct of other determined cause, % (n) 10% (6) Infarct of undetermined cause, % (n) 11% (7) Location of occlusion Proximal (M1) middle cerebral artery, % (n) 35% (22) Distal (M2) middle cerebral artery, % (n) 19% (12) Terminal internal carotid artery, % (n) 37% (23) Anterior cerebral artery, % (n) 2% (1) Posterior cerebral artery, % (n) 2% (1) Top of the basilar, % (n) 5% (3) Median elapsed time from symptom onset to initiation of intravenous thrombolysis, min (IQR)…”

“…32 In the present study, we evaluated recanalization using the TIMI grading score, given the familiarity and extensive experience of our group with the former score. 4,12,15,16 Moreover, previous studies comparing the diagnostic accuracy of TCD against DSA for assessing recanalization have also used the TIMI grading score. 9 Finally, DSA collateral vessel grading was not systematically measured at baseline because the aim of the present study was to evaluate the correlation of TCD versus DSA in assessing recanalization.…”

“…[12][13][14][15][16] We sought to capitalize on our experience and prospectively investigate the diagnostic accuracy of ultrasound criteria for recanalization against DSA in AIS patients, who underwent IA reperfusion procedures with simultaneous real-time TCD monitoring in an international, multicenter study. We further thought to confirm that ultrasound detection of recanalization by our criteria is associated with good functional outcomes at 3 months…”

Intra-Arterial Delivery of Cell Therapies for Stroke

“…Other agents have been administered IA in the intracranial circulation at 1 cc/ min such as verapamil for vasospasm and t-PA for central retinal artery occlusion [52][53][54]. Delivery of oxygenated arterial blood distal to the occlusive thrombus during acute stroke interventions using a microcatheter has been found to be safe and feasible at a reported rate of 10cc/min [55,56]. It is conceivable that IA infusion of cells comparable in size to red blood cells in the intracranial vasculature at this rate could be safe and justified for further clinical trials.…”